Multiple studies have compared cardiovascular risk factors and cardiovascular outcomes in African American and white populations. These comparisons implicitly assume relative homogeneity in risk within race/ethnic groups. Although few studies have explicitly investigated heterogeneity in cardiovascular risk within African Americans, there is evidence that cardiovascular mortality, subclinical atherosclerosis, and other cardiovascular risk factors exhibit important heterogeneity often associated with social and geographic factors. Understanding factors associated with this heterogeneity is important for reducing the burden of cardiovascular disease in African Americans and for reducing health disparities. The Jackson Heart Study (JHS), with its large sample size, state-of-the-art data collection, extensive socio-cultural assessment, and detailed behavioral and biological measures provides a unique opportunity to examine social determinants of heterogeneity in cardiovascular risk within an African American cohort. The overall goal of this project is to examine social and geographic predictors of heterogeneity in cardiovascular risk within African-Americans. This goal will be accomplished through analysis of data from the Jackson Heart Study and by comparing Jackson data to similarly collected data obtained from African Americans residing in other parts of the country participating in the Multi-Ethnic Study of Atherosclerosis. Specific aims are: (1) To examine social predictors of established cardiovascular risk factors and cardiovascular events in the Jackson Heart Study. (2) To examine the contribution of psychosocial measures of particular relevance in African American populations (such as discrimination, John Henrysim, and chronic stress) to the social patterning of cardiovascular risk factors and cardiovascular outcomes. In addition, we will also examine the behavioral and biological mechanisms through which these social and psychosocial effects operate including biomarkers associated with, or affected by, the stress response such serum cortisol, blood pressure, abdominal obesity, insulin resistance, and markers of inflammation. (3) To examine geographic variability in the risk factors and biological markers; and (4) To determine whether any geographic differences observed are attributable to geographic differences in social factors or in the relationship between social factors and risk factors. These Aims will be achieved through a collaboration between the University of Michigan and the Jackson Heart Study (including its two partners Jackson State University and the University of Mississippi Medical Center). In addition to the scientific aims, a major goal of this project is to enhance the scientific productivity of JHS generally, with a special emphasis on enhancing the capacity and productivity of JHS investigators at Jackson State and facilitating the career development of minority investigators.